Can Lyrica (pregabalin) cause gastric ulcers?

Lyrica (Pregabalin) and Gastric Ulcers

Lyrica (pregabalin) is not known to cause gastric ulcers, unlike NSAIDs which are well-documented to increase the risk of gastrointestinal toxicity including gastric ulcers.

Medications Associated with Gastric Ulcers

NSAIDs and Gastric Ulcers

• NSAIDs significantly increase the risk of gastrointestinal (GI) toxicity, with peptic ulcer and ulcer complications being well-documented adverse effects 1
• The annual incidence of NSAID-related upper GI events is 2.0% to 4.5%, with risk of bleeding, perforation, or obstruction at 0.2% to 1.9% 1
• NSAID use has been estimated to account for approximately 107,000 hospitalizations and 16,500 deaths per year among patients with arthritis in the United States 1

Risk Factors for NSAID-Induced Ulcers

• Highest risk factors include:
  • Previous history of peptic ulcer or ulcer complications
  • Concurrent use of multiple NSAIDs (including low-dose aspirin)
  • Concomitant use of anticoagulants or steroids
  • Advanced age (≥60 years)
  • H. pylori infection 1

Pregabalin (Lyrica) and GI Effects

• There is no evidence in the medical literature that pregabalin causes gastric ulcers

• Pregabalin's most common GI side effects include:

  • Constipation (reported as severe and disabling in some cases, affecting up to 7.5% of patients) 2
  • Dizziness (reported in 51.6% of patients in one study) 3

• In clinical trials studying pregabalin for irritable bowel syndrome and functional dyspepsia:

  • Pregabalin actually showed improvement in abdominal pain, bloating, and diarrhea symptoms in IBS patients 4
  • Pregabalin demonstrated significant alleviation of dyspeptic symptoms in patients with functional dyspepsia 3

Gastroprotection Strategies for High-Risk Patients

While not directly relevant to pregabalin use, patients on medications that do cause gastric ulcers (such as NSAIDs) should consider the following:

• Proton pump inhibitors (PPIs) are the preferred agents for therapy and prophylaxis of NSAID-associated GI injury 1
• PPIs are superior to H2-receptor antagonists for preventing gastric ulcers in patients using high doses of NSAIDs 1
• H2-receptor antagonists may be a reasonable alternative in patients at lower risk for GI bleeding 1
• Misoprostol can reduce gastric ulcer risk but has limitations due to side effects like diarrhea 1

Clinical Implications

• When prescribing pregabalin, clinicians should monitor for its known adverse effects (dizziness, somnolence, constipation) rather than gastric ulcers
• If a patient on pregabalin develops symptoms suggestive of gastric ulcers, consider other causes:
  • Concurrent NSAID use
  • H. pylori infection
  • Other medications that may cause gastric irritation
  • Alcohol consumption

Conclusion

Based on available evidence, pregabalin (Lyrica) is not associated with causing gastric ulcers. The primary gastrointestinal concerns with pregabalin use are constipation and, in some cases, improvement in certain GI symptoms when used for conditions like IBS or functional dyspepsia.